JAMA: "Worldwide Preparedness for Kidney Health Care"

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By ASN Staff

The Journal of the American Medical Association (JAMA) published an editorial by Sreedhar Mandayam, MD, MPH and Wolfgang C. Winkelmayer, MD, MPH, ScD about the level of preparedness for kidney care worldwide.

“Among noncommunicable diseases, kidney diseases have not garnered as much attention as other conditions, such as cardiovascular disease, cancers, or chronic respiratory diseases, which constitute the 3 leading categories of noncommunicable disease causes of death. Kidney diseases, however, are common and consequential, and increasingly so.

In this issue of JAMA, Bello et al15 present the results of a survey by questionnaire conducted by the International Society of Nephrology using purposive sampling of key stakeholders such as clinicians, policy makers, and patient organization representatives in 130 countries about the core areas of each country’s capacity and response for kidney care. The investigators achieved an excellent response rate: 289 of 337 respondents provided detailed information on the state of kidney care in 125 of the 130 countries, representing an estimated 93% of the world’s population (6.8 billion people). Not unexpectedly, the wealth of data obtained provided clear evidence of considerable variations among countries in several kidney health care–relevant domains: workforce and training opportunities, service delivery, data collection and information systems, and financing. Only 18% of countries reported routine availability of serum creatinine measurements with estimation of GFR and 8% of countries reported routine proteinuria measurement, both critical tools for recognition and monitoring of CKD in primary care. Important, and the most cost-effective, treatment modes for end-stage kidney disease such as peritoneal dialysis and kidney transplantation were available in 80% of all countries but showed significant regional differences, with only 40% of African countries able to provide either service. A large swath of the world (Africa, the Middle East, South East Asia, and Oceania) has fewer than 10 nephrologists per 1 million population, highlighting some serious workforce shortages. In addition, only 7% to 8% of countries reported having robust health registries specifically for acute kidney injury and nondialysis CKD, again vital for implementation of strategies to reduce the burden of kidney diseases.

Knowledge is power, so defining the problem is a crucial first step toward resource planning. Considering that only 8% of countries, mostly in the West, have information systems that register and report the occurrences of acute kidney injury or CKD, most of the world does not have the infrastructure in place to determine burden of illness caused by kidney disease to its people and, hence, is unable to develop a data-driven kidney health policy or to rationally prioritize scarce resources toward improving kidney health.”

Read the full article.

Resources:

1 Mandayam, S., & Winkelmayer, W. C. (2017, April 21). Worldwide Preparedness for Kidney Health Care. Retrieved April 24, 2017, from http://jamanetwork.com/journals/jama/fullarticle/2623224

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The Journal of the American Medical Association (JAMA) published an editorial by Sreedhar Mandayam, MD, MPH and Wolfgang C. Winkelmayer, MD, MPH, ScD about the level of preparedness for kidney care worldwide.

“Among noncommunicable diseases, kidney diseases have not garnered as much attention as other conditions, such as cardiovascular disease, cancers, or chronic respiratory diseases, which constitute the 3 leading categories of noncommunicable disease causes of death. Kidney diseases, however, are common and consequential, and increasingly so.

In this issue of JAMA, Bello et al15 present the results of a survey by questionnaire conducted by the International Society of Nephrology using purposive sampling of key stakeholders such as clinicians, policy makers, and patient organization representatives in 130 countries about the core areas of each country’s capacity and response for kidney care. The investigators achieved an excellent response rate: 289 of 337 respondents provided detailed information on the state of kidney care in 125 of the 130 countries, representing an estimated 93% of the world’s population (6.8 billion people). Not unexpectedly, the wealth of data obtained provided clear evidence of considerable variations among countries in several kidney health care–relevant domains: workforce and training opportunities, service delivery, data collection and information systems, and financing. Only 18% of countries reported routine availability of serum creatinine measurements with estimation of GFR and 8% of countries reported routine proteinuria measurement, both critical tools for recognition and monitoring of CKD in primary care. Important, and the most cost-effective, treatment modes for end-stage kidney disease such as peritoneal dialysis and kidney transplantation were available in 80% of all countries but showed significant regional differences, with only 40% of African countries able to provide either service. A large swath of the world (Africa, the Middle East, South East Asia, and Oceania) has fewer than 10 nephrologists per 1 million population, highlighting some serious workforce shortages. In addition, only 7% to 8% of countries reported having robust health registries specifically for acute kidney injury and nondialysis CKD, again vital for implementation of strategies to reduce the burden of kidney diseases.

Knowledge is power, so defining the problem is a crucial first step toward resource planning. Considering that only 8% of countries, mostly in the West, have information systems that register and report the occurrences of acute kidney injury or CKD, most of the world does not have the infrastructure in place to determine burden of illness caused by kidney disease to its people and, hence, is unable to develop a data-driven kidney health policy or to rationally prioritize scarce resources toward improving kidney health.”

Read the full article.

Resources:

1 Mandayam, S., & Winkelmayer, W. C. (2017, April 21). Worldwide Preparedness for Kidney Health Care. Retrieved April 24, 2017, from http://jamanetwork.com/journals/jama/fullarticle/2623224